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I still remember my first patient in medical school as if it was yesterday.

It was the summer of 2000 when I started my surgical clerkship in a large county hospital. That place had anything and everything one could possible imagine with respect to the spectrum of disease and humanity. Young, old, a ton of homeless patients, drug and alcohol addicts, psychiatric illness galore… The Emergency Room was more like a zoo when one considers the noises and the smells there…

So with this context in mind, imagine my first week on the surgical rotation. My first patient was a homeless 60-year-old man who smoked 1-2 packs per day for about 45 years. As a result he had severe vascular disease and was in the process of losing his leg to dry gangrene due to lack of circulation. To make the problem worse, he became addicted to narcotic pain medicine while in the hospital.

I walked into his room one day on rounds to examine him, and irritated he said to leave him alone because he needs to focus. Focus on what?

Then I noticed he was holding his Morphine PCA (patient controlled analgesia) button in his hand and looking at the medication pump screen intensely. He figured out the PCA formula down to the last detail, and was trying to maximize the amount of narcotic he would receive from the machine.

He figured out that the machine would dispense a morphine bolus only after a 10 minute lock out. Furthermore, as a safety check, the machine was programmed to dispense a certain maximum amount each hour regardless of the lockout intervals and the number of times the patient pushes the button. He learned the way the machine worked, and when I walked in he knew he had about 5 minutes before it would respond to another push.

He was so focused on counting down the minutes and seconds to the expiration of the lockout interval that he would not even talk to me about the grand picture, which was the upcoming surgery to fix the problem in his leg.

This world and the sin around us work in a similar way.

Those who have not found God are so entrenched into the world and into sin that they cannot grasp the big picture. They would rather focus on the next vain pleasure than step back and realize that they are on the road to perdition.

Consider what Paul writes in Romans 6:23 about the outcome of being a slave to sin:

“For the wages of sin is death, but the free gift of God is eternal life in Christ Jesus our Lord”

There is considerable evidence, biblical and extra-biblical, that apostle Peter was martyred for his Christian faith.

Jesus told Peter regarding his death in John 21:18-19:

“18 Truly, truly, I say to you, when you were young, you used to dress yourself and walk wherever you wanted, but when you are old, you will stretch out your hands, and another will dress you and carry you where you do not want to go.” 19 (This he said to show by what kind of death he was to glorify God.)”

This is one of the passages in the Bible which demonstrates that martyrdom for faith in God is an act of glorification of God. If this brief conversation at the end of John’s gospel was the only one referencing Peter’s martyrdom, we would still be believe in the martyrdom of Peter because it is found in the Bible.

But there are also a number of non-canonical and historical accounts which mention Peter’s execution.

Peter was approximately 65 years old when he died in Rome, probably in 64 AD, possibly during the Neronian persecution in the months that followed the Great Fire of Rome.

Clement of Rome (d. 101 AD) who was likely ordained pastor (bishop/pope) by Peter wrote in his Letter to the Corinthians:

“Let us take the noble examples of our own generation. Through jealousy and envy the greatest and most just pillars of the Church were persecuted, and came even unto death… Peter, through unjust envy, endured not one or two but many labours, and at last, having delivered his testimony, departed unto the place of glory due to him.“

Christian writer Tertullian (160–c. 225 AD) wrote:

“Since, moreover, you are close upon Italy, you have Rome, from which there comes even into our own hands the very authority (of apostles themselves). How happy is its church, on which apostles poured forth all their doctrine along with their blood; where Peter endures a passion like his Lord’s“

Origen (185 – 254 AD) wrote in Eusebius, Church History III.1:

“Peter was crucified at Rome with his head downwards, as he himself had desired to suffer.”

According to this account, Peter did not deem himself worthy to die in the same manner as his Savior, but willingly endured an upside down crucifixion.

How did Peter end up in Rome during Nero’s persecution?

Apocryphal writings and church tradition say that Peter saw Jesus in a vision and Peter inquired “where are you going, Master?” to which Jesus answered “I am going to Rome to be crucified, again.” Tradition says this is when Peter made the decision to go back to Rome and accept martyrdom.

We will look at the martyrdom and persecution of other apostles in upcoming posts.

Losing a family member, especially a young son or daughter is the most painful event one can go through. Our condolences go to pastor Rick Warren and his family who lost their son to suicide after a long struggle with depression and suicidal ideation.

Delight in Truth is a critic of Rick Warren and some of the positions he has taken over the years with respect to controversial social issues, but this tragedy makes everything pale in comparison.

Doctrinal points, accuracy of biblical teaching, styles of sharing the Gospel and their controversies matter not at this time.

The only thing that matters is the comfort that God can provide to Rick Warren and his family via the Holy Spirit, our Comforter.

There will be time to talk about mental illness, suicide, antidepressant treatment, and salvation issues in the setting of suicide.

Now we grieve with the Warren family for their loss.

Psalm 18:2 “The LORD is my rock, my fortress and my deliverer; my God is my rock, in whom I take refuge. He is my shield and the horn of my salvation, my stronghold.”

It is commonly taught that the victim of crucifixion would die from asphyxiation. Many of those crucified would live three or more days before their neck muscles would no longer be able to support the 12 lbs (5.5 kg) weight of their head. Airway obstruction subsequently would set in and the victim would suffocate to death.

Such a patho-physiologic event is sometimes ascribed to the death of Jesus.

However, biblical narrative and medical correlation would indicate that Jesus’s cause of death was multifactorial, and that He died suddenly from an acute internal event and not suffocation.

But first let us review some of Christ’s stresses and injuries that set up his unusually quick death on the cross.

1. Less than 18 hours before his death, the physician and evangelist Luke tells us that Jesus was in extreme physical and psychological anguish: “being in an agony, He prayed more earnestly; and His sweat became like great drops of blood.” (Luke 22:44) Luke may be referring to the phenomenon of hemohydrosis where sweat glands may bleed under extreme stress, just like in the case of coagulation disorders. This may be indicative of the extreme level of stress the Savior was under as He was approaching the time of God’s wrath being poured on Him.

2. Jesus probably walked 2-3 miles between various places (trials and questioning) in the 12 hours prior to crucifixion, likely without hydration.

3. Jesus received blows to the face and His body as part of being mocked (Luke 22:63-65).

4. Friday morning before being delivered to be crucified, Jesus was severely flogged (John 19:1). This was a Roman judicial penalty where the victim was beat with a multi-lashed whip containing embedded pieces of bone and metal. As the blows landed on Jesus’s back and thighs, the whip ripped into skin, subcutaneous tissue and muscle, tearing blood vessels and nerves in the process. This particular event weakened the Savior tremendously due to blood loss and severe pain. Exposing His tissues on a cold early morning also initiated hypothermia which led to coagulation defects and further loss of blood.

5. The severe beating and blood loss likely led to orthostatic hypotension (low blood pressure when standing) as Jesus was unable to carry the crossbar of the cross (75-100 lbs) and was forced to walk or perhaps drag Himself on Via Dolorosa.

6. At this point, even before crucifixion, Jesus was in critical medical condition. An older man with medical issues would have died by now. Even by modern medical standards, a 33-year-old healthy man would likely have to be taken to the operating room for wound debriment, tissue reconstruction, fluid resuscitation, warming, and blood transfusion. All this followed by a long recovery in the intensive care unit with possible complications of infection and kidney failure.

Up to this point Jesus suffered severe trauma and was in dire need of resuscitation. In this critical state He is delivered up for crucifixion.

It was the custom for nails to be driven in the hands (wrists) and legs of the victim during crucifixion which compounded blood loss. In the case of Jesus, the hemorrhage became critical as His wounded back was pressing and rubbing against the tree. As a trauma victim who sustained significant hemorrhage, Jesus became very thirsty and cried: “I thirst.” They offered Him an analgesic consisting of wine and myrrh, but He refused.

This brings us to the climatic event. What exactly caused Jesus’s death?

Biblical narrative demonstrates that Jesus had a sudden death, and not a prolonged period of suffocation as was the case in most crucifixions. All four Gospels present Jesus as crying out with a loud voice (in the case of John, He says: “It is finished”) and immediately dies. This is unlikely to be a death from asphyxiation.

There is no evidence in the narrative of the Gospels that in the short time Jesus was on the cross (less than 6 hours) He was suffocating. On the contrary, despite His weakened state, we see Him conversing with various people while on the cross. This is strong evidence that He was able to maintain a patent airway up until His last breath!

It is more likely that Jesus died of a sudden internal catastrophe. The highest ranking possibility is a lethal arrhythmia (abnormal heart rhythm) potentially caused by electrolyte disturbances from severe dehydration and hemorrhage.

Others have postulated a tension hemothorax (accumulation of blood around one lung) which led to an acute drop in blood pressure and immediate death. This diagnosis may be supported by the blood that flowed from the Savior’s side after His spearing. Red blood flowed from His side (settled red cells), followed by serum (clear fluid that may look like water) which is found at the top of any settled blood sample that does not circulate.

Other possibilities include a trauma-induced tear in one of the atria of the heart leading to cardiac tamponade (blood around the heart), or perhaps a sudden pneumothorax (dropped lung).

All of the above descriptions would correlate well with the Gospel accounts of a sudden death after what appeared to be a loud statement by Jesus. A prolonged dying process by suffocation can thus almost be ruled out.

Whatever the exact pathologic event was that caused the Savior to give His last breath, one thing remains certain.

He died with certainty.

And this is important because His death made His resurrection a truly miraculous event, the greatest event in the history of the universe to date!

For a JAMA article on the scourging and crucifixion of Jesus, click here